Hypokalemia After Rituximab Administration in Steroid-Dependent Nephrotic Syndrome: A Case Report

Abstract

The monoclonal antibody rituximab is a commonly used steroid sparing agent for steroiddependent idiopathic nephrotic syndrome of childhood. With this brief report, we describe the first case of symptomatic hypokalemia after intravenous rituximab administration in a young woman. The sudden onset of dizziness and palpitation prompted acute lifethreatening hypokalemia recognition by blood gas analysis and electrocardiography. Her symptoms were rapidly controlled by intravenous potassium administration. Such adverse drug reactions, when mild and self-limiting, can easily be overlooked if not expected or investigated. Health professionals should take into account the possibility of acute hypokalemia after rituximab administration in order to promptly setup the appropriate treatment and limit potentially severe complications.

Hypokalemia after rituximab administration in nephrotic syndrome: two case reports

“…Hypokalemia is a significant adverse event in hospitalized patients that may trigger cardiac arrhythmias and/or respiratory arrest. Only one case of hypokalemia caused by rituximab administration has been reported in the literature as yet [ 15 ]. To reduce prednisone dependence, a young woman diagnosed with idiopathic NS was started on rituximab.…”

Advances in the treatment of refractory nephrotic syndrome in children

“…Hypogammaglobulinemia is mostly present in children with low IgG levels, and low IgG levels and a previous history of SRNS are high risk factors for hypogammaglobulinemia after RTX treatment [31] , and most patients with hypogammaglobulinemia are complicated by infections [32] ; therefore, regular testing of immunoglobulins before and after RTX requires replacing immunoglobulins with individualized regimens [33] . Previous studies [34][35][36][37][38] have reported more specific adverse effects, including serum sickness, hypokalemia, hypersensitivity reactions, disseminated intravascular coagulation, and Crohn's disease.Kobayash et al [39] conducted a retrospective study to monitor the safety of RTX for RNS, adverse drug reactions were observed in 53.7% of patients, infections in 24% of patients, infusion reactions in 31.9% of patients, and no RTX-specific adverse reactions were observed, consistent with the known safety profile of RTX, which can be safely used in patients with RNS.…”